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1.
J Clin Oncol ; : JCO1902654, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32182156

RESUMO

PURPOSE: Lifirafenib is an investigational, reversible inhibitor of B-RAFV600E, wild-type A-RAF, B-RAF, C-RAF, and EGFR. This first-in-human, phase I, dose-escalation/dose-expansion study evaluated the safety, tolerability, and efficacy of lifirafenib in patients with B-RAF- or K-RAS/N-RAS-mutated solid tumors. METHODS: During dose escalation, adult patients with histologically/cytologically confirmed advanced solid tumors received escalating doses of lifirafenib. Primary end points were safety/tolerability during dose escalation and objective response rate in preselected patients with B-RAF and K-RAS/N-RAS mutations during dose expansion. RESULTS: The maximum tolerated dose was established as 40 mg/d; dose-limiting toxicities included reversible thrombocytopenia and nonhematologic toxicity. Across the entire study, the most common grade ≥ 3 treatment-emergent adverse events were hypertension (n = 23; 17.6%) and fatigue (n = 13; 9.9%). One patient with B-RAF-mutated melanoma achieved complete response, and 8 patients with B-RAF mutations had confirmed objective responses: B-RAFV600E/K melanoma (n = 5, including 1 patient treated with prior B-RAF/MEK inhibitor therapy), B-RAFV600E thyroid cancer/papillary thyroid cancer (PTC; n = 2), and B-RAFV600E low-grade serous ovarian cancer (LGSOC; n = 1). One patient with B-RAF-mutated non-small-cell lung cancer (NSCLC) had unconfirmed partial response (PR). Patients with K-RAS-mutated endometrial cancer and K-RAS codon 12-mutated NSCLC had confirmed PR (n = 1 each). No responses were seen in patients with K-RAS/N-RAS-mutated colorectal cancer (n = 20). CONCLUSION: Lifirafenib is a novel inhibitor of key RAF family kinases and EGFR, with an acceptable risk-benefit profile and antitumor activity in patients with B-RAFV600-mutated solid tumors, including melanoma, PTC, and LGSOC, as well as K-RAS-mutated NSCLC and endometrial carcinoma. Future comparisons with first-generation B-RAF inhibitors and exploration of lifirafenib alone or as combination therapy in patients with selected RAS mutations who are resistant/refractory to first-generation B-RAF inhibitors are warranted.

2.
J Phys Chem A ; 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32207624

RESUMO

We report a study of the structure and bonding of a transition metal doped boron cluster, MnB6-, using high-resolution photoelectron imaging and quantum chemical calculations. Vibrationally-resolved photoelectron spectra indicate a significant geometry change between the anionic and neutral ground states of MnB6. The electron affinity of MnB6 is measured to be 2.4591(5) eV, as well as vibrational frequencies for five of its vibrational modes. The experimental data are combined with theoretical calculations to determine the structure and bonding of MnB6-, which is found to be planar with a B-centered hexagonal structure (C2v symmetry) and a quintet spin state (5A2). Nuclear-independent chemical shift calculations indicate that MnB6- is aromatic. Molecular orbital analyses reveal that MnB6- contains three π orbitals, one of which is singly occupied. Hence, MnB6- can be considered as an open-shell metallaboron analog of 3d metallabenzenes.

3.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(3): 199-204, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-32204753

RESUMO

The epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues so far. The cases of SARS-CoV-2 infection have been reported in pregnant women and neonates as special groups. Perinatal and neonatal management plan for prevention and control of SARS-CoV-2 infection (2nd Edition) has been worked out by the Editorial Committee of Chinese Journal of Contemporary Pediatrics. This paper presents an interpretation on the 2nd Edition of the management plan, so as to facilitate readers to better understand it.

4.
J Crohns Colitis ; 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32179884

RESUMO

BACKGROUND AND AIMS: LAG-3 is an immune checkpoint and its expression identifies recently activated lymphocytes that may contribute to inflammation. We investigated the role of LAG-3 by analysing its expression and function in immune cells from blood and tissue of patients with ulcerative colitis (UC). METHODS: Phenotypic properties of LAG-3+ T cells were determined by flow cytometry, qRT-PCR and single-cell RNA-sequencing. LAG-3+ cells were quantified and correlated with disease activity. The functional effects of LAG-3+ cells were tested using a depleting anti-LAG-3 monoclonal antibody (mAb) in a mixed lymphocyte reaction (MLR). RESULTS: LAG-3+ cells in the blood was negligible. LAG-3+ lymphocytes were markedly increased in inflamed mucosal tissue and both frequencies of LAG-3+ T cells and transcript levels of LAG3 correlated with endoscopic severity. LAG-3 expression was predominantly on effector memory T cells and single-cell RNA-sequencing revealed LAG3 expression in activated and cytokine-producing T cell subsets. Foxp3+CD25hi Tregs also expressed LAG-3, although most mucosal Tregs were LAG-3-. Mucosal LAG-3+ cells produced mainly IFNγ and IL-17A. LAG-3+ cell numbers decreased in patients who responded to biologics, and remained elevated in non-responders. Treatment with a depleting anti-LAG-3 mAb led to a reduction in proliferation and IFNγ production in a MLR. CONCLUSIONS: LAG-3+ cells are increased in the inflamed mucosa, predominantly on effector memory T cells with an activated phenotype and their cell numbers positively correlate with disease activity. Depleting LAG-3 eliminates activated proliferating T cells, hence LAG-3 could be a therapeutic target in UC.

5.
J Am Chem Soc ; 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32039591

RESUMO

Möbius aromaticity was developed for twisted annulenes with electron counting rules opposite to those of Hückel aromaticity. The introduction of transition metals makes it possible for planar cyclic systems to exhibit Möbius aromaticity. Here we report the first planar monocyclic metallaboron systems with Möbius aromaticity. The structures and bonding of two rhenium-boride clusters are studied by high-resolution photoelectron imaging and ab initio calculations. The ReB3- cluster is shown to have a near-pyramidal structure, while ReB4- is found to be a planar pentagonal ring. Chemical bonding analyses show that both ReB4- and ReB4 possess four delocalized π-electrons, including two π-electrons in an orbital of Möbius topology. NICS calculations reveal strong aromatic characters in ReB4- and ReB4, consistent with the 4n electron counting rule for Möbius aromaticity.

6.
Sci Rep ; 10(1): 2489, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32051492

RESUMO

Neoadjuvant chemotherapy (NAC) combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy (CC) will be the new standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) patients. However, many patients fail to receive CC for multiple reasons. We aimed to investigate long-term survival outcomes and toxicities in these patients with NPC treated with additional NAC plus concurrent chemoradiotherapy (CCRT) or IMRT alone. In total, 1,378 previously untreated, newly diagnosed locoregionally advanced NPC patients receiving NAC plus IMRT with or without CC were retrospectively reviewed. We used a propensity score-matched (PSM) method with 1:1 matching to identify paired patients according to various covariates. Survival outcomes and toxicities were compared between the two groups. In total, 288 pairs were identified. With a median follow-up of 86 (range: 8-110) months, the estimated 5-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival rates in patients treated with NAC plus CCRT vs. NAC plus IMRT alone were 96.1% vs. 94.7% (P = 0.201), 93.7% vs. 89.8% (P = 0.129), 91.3% vs. 85.1% (P = 0.024), and 93.0% vs. 90.6% (P = 0.362), respectively. Multivariate analysis showed that CC omission was a prognostic factor for worse PFS. In a subgroup analysis, PFS did not differ significantly between two groups of female patients or aged <60 years or stage T1-2 or stage N0-1 disease. However, fewer acute complications were observed in the NAC plus IMRT alone group. NAC with IMRT alone confers similar survival rates and less acute toxicities. Specifically, NAC plus IMRT alone may be enough for female patients <60 years with stage T1-2 or stage N0-1. However, a prospective randomised trial is needed to validate these results.

7.
Nat Commun ; 11(1): 899, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32060313

RESUMO

The human gut microbiota plays a central role not only in regulating the metabolism of nutrients but also promoting immune homeostasis, immune responses and protection against pathogen colonization. The genome of the Gram-negative symbiont Bacteroides thetaiotaomicron, a dominant member of the human intestinal microbiota, encodes polysaccharide utilization loci PULs, the apparatus required to orchestrate the degradation of a specific glycan. EndoBT-3987 is a key endo-ß-N-acetylglucosaminidase (ENGase) that initiates the degradation/processing of mammalian high-mannose-type (HM-type) N-glycans in the intestine. Here, we provide structural snapshots of EndoBT-3987, including the unliganded form, the EndoBT-3987-Man9GlcNAc2Asn substrate complex, and two EndoBT-3987-Man9GlcNAc and EndoBT-3987-Man5GlcNAc product complexes. In combination with alanine scanning mutagenesis and activity measurements we unveil the molecular mechanism of HM-type recognition and specificity for EndoBT-3987 and an important group of the GH18 ENGases, including EndoH, an enzyme extensively used in biotechnology, and for which the mechanism of substrate recognition was largely unknown.

8.
J Phys Chem Lett ; 11(3): 659-663, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-31913630

RESUMO

The maximum bond order between two main-group atoms was known to be three. However, it has been suggested recently that there is quadruple bonding in C2 and analogous eight-valence electron species. While the quadruple bond in C2 has aroused some debates, an interesting question is: are main-group elements capable of forming quadruple bonds? Here we use photoelectron spectroscopy and computational chemistry to probe the electronic structure and chemical bonding in RhB2O- and RhB- and show that the boron atom engages in quadruple bonding with rhodium in RhB(BO)- and neutral RhB. The quadruple bonds consist of two π-bonds formed between the Rh 4dxz/4dyz and B 2px/2py orbitals and two σ-bonds between the Rh 4dz2 and B 2s/2pz orbitals. To confirm the quadruple bond in RhB, we also investigate the linear Rh≡B-H+ species and find a triple bond between Rh and B, which has a longer bond length, lower stretching frequency, and smaller bond dissociation energy in comparison with that of the Rh≣B quadruple bond in RhB.

9.
Environ Sci Pollut Res Int ; 27(1): 1024-1034, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31820250

RESUMO

Ecological stoichiometry represents the balance of nutrient elements under ecological interactions, which are crucial for biogeochemical cycles in ecosystems. Little is known about carbon (C), nitrogen (N), and phosphorus (P) ecological stoichiometry in aboveground biomass, roots, and soil, especially in the subtropical riparian wetlands. Here, eight dominate plant communities in riparian wetlands were chosen, and C, N, and P contents, and C:N:P ratios of aboveground biomass, roots, and soil were investigated. The results demonstrated that plant community had remarkable effects on the C:N:P stoichiometry in aboveground biomass, roots, and soil, which varied widely. C, N, and P concentrations in aboveground biomass were mostly higher than that in roots, while no significant difference was detected in C:N:P ratios. Moreover, there were higher soil C, N, and P contents in Cannabis indica plant communities; while lower soil N:P ratios suggested that riparian wetlands were more susceptible to N limitation, rather than P. Pearson correlation analysis and redundancy analysis (RDA) showed that there were strong associations among C, N, and P contents, and C:N:P ratios in aboveground biomass, roots, and soil, indicating that C, N, and P ecological stoichiometry of aboveground biomass were regulated by soil C, N, and P contents through the roots. In addition, the contents of C and N, and N and P exhibited a strong relationship according to linear regression. These findings suggested that the interactions among the C, N, and P stoichiometry were existed in the plant-soil system.

10.
Xenobiotica ; 50(2): 150-169, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31006307

RESUMO

Asciminib is a potent, specific BCR-ABL1 inhibitor being developed for the treatment of patients with chronic myelogenous leukemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukemia (Ph + ALL).Here, we present the results of human oral absorption, distribution, metabolism, excretion (ADME) and in vitro studies that together provide an overall understanding of the metabolism, distribution and clearance of asciminib in humans.Asciminib was rapidly absorbed with a maximum plasma concentration at two hours post-dose. Total radioactivity and asciminib showed similar terminal half-lives in plasma.Oral asciminib absorption ranged between a minimum of 33%, and a maximum of 57% based on the metabolite profiles of late time-point feces collections.Asciminib was eliminated mainly through feces via unchanged asciminib excretion and metabolism.Direct glucuronidation and oxidation were major metabolic pathways in human that were catalyzed predominantly by UDP-glucuronosyltransferase (UGT)2B7 and cytochrome P450 (CYP)3A4, respectively.The relative contribution of the glucuronidation pathway to the total clearance of asciminib via metabolism is estimated to range ∼28-58%, whereas the relative contribution of the oxidative pathway is estimated to range ∼37-64%, based upon the maximum oral absorption in humans.

12.
Methods Mol Biol ; 2103: 249-262, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31879931

RESUMO

Glycosylation is one of the most common posttranslational modifications of proteins and can exert profound effects on the inherent properties and biological functions of a given protein. Structurally well-defined homogeneous glycopeptides are highly demanded for functional studies and biomedical applications. Various chemical and chemoenzymatic methods have been reported so far for synthesizing different N- and O-glycopeptides. Among them, the chemoenzymatic method based on an endoglycosidase-catalyzed ligation of free N-glycans and GlcNAc-tagged peptides is emerging as a highly efficient method for constructing large complex N-glycopeptides. This chemoenzymatic approach consists of two key steps. The first step is to prepare the GlcNAc peptide through automated solid-phase peptide synthesis (SPPS) by incorporating an Asn-linked GlcNAc moiety at a predetermined glycosylation site; and the second step is to transfer an N-glycan from the corresponding N-glycan oxazoline en bloc to the GlcNAc peptide by an endoglycosidase or its efficient glycosynthase mutant. In this chapter, we provide detailed procedures of this chemoenzymatic method by demonstrating the synthesis of two HIV-1 V3 glycopeptide antigens carrying a high-mannose-type and a complex-type N-glycan, respectively. The described procedures should be generally applicable for the synthesis of other biologically important N-glycopeptides.

13.
Med Sci Monit ; 25: 8230-8241, 2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31677259

RESUMO

BACKGROUND With the progress in surgical techniques and management of complications, pancreatic resection can be safely performed in experienced hospitals. Pancreatic resection enables surgeons to assess the effect of surgery for metastatic cases, even when there is limited information. In the present study we evaluated the role of primary tumor resection for metastatic pancreatic cancer (mPC) by using the Surveillance, Epidemiology and End Results (SEER) database. MATERIAL AND METHODS Metastatic pancreatic cancer patients treated at our hospital from 2004 to 2015 were identified. The effect of surgery on cancer-specific survival was assessed by restricted mean survival time (RMST) and stabilized inverse probability of treatment weight-adjusted analysis after propensity score matching (PSM). RESULTS A total of 2694 mPC patients were included. Of this population, 365 adults underwent primary tumor resection. After propensity matching, postsurgical patients had longer RMST than non-surgery patients (1: 1 PSM 11.60 months vs. 8.98 months; 1: 2 PSM 11.61 months vs. 9.10 months; p<0.01). Stabilized inverse probability of treatment weight-adjusted analysis yielded similar results (p<0.01). CONCLUSIONS Our study supports the hypothesis that patients with mPC can benefit from primary tumor surgery. However, the surgical inclusion criteria and the appropriate role of surgery, such as its effect on symptom control, quality of life, and the extent to which it prolongs survival for metastatic pancreatic cancer, remain to be completely assessed by well-designed, prospective, randomized clinical trials.

14.
Adv Sci (Weinh) ; 6(22): 1901240, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31763143

RESUMO

Tissue engineering produces constructs with defined functions for the targeted treatment of damaged tissue. A complete spinal cord injury (SCI) model is generated in canines to test whether in vitro constructed neural network (NN) tissues can relay the excitatory signal across the lesion gap to the caudal spinal cord. Established protocols are used to construct neural stem cell (NSC)-derived NN tissue characterized by a predominantly neuronal population with robust trans-synaptic activities and myelination. The NN tissue is implanted into the gap immediately following complete transection SCI of canines at the T10 spinal cord segment. The data show significant motor recovery of paralyzed pelvic limbs, as evaluated by Olby scoring and cortical motor evoked potential (CMEP) detection. The NN tissue survives in the lesion area with neuronal phenotype maintenance, improves descending and ascending nerve fiber regeneration, and synaptic integration with host neural circuits that allow it to serve as a neuronal relay to transmit excitatory electrical signal across the injured area to the caudal spinal cord. These results suggest that tissue-engineered NN grafts can relay the excitatory signal in the completely transected canine spinal cord, providing a promising strategy for SCI treatment in large animals, including humans.

15.
Nanoscale ; 11(48): 23286-23295, 2019 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-31782482

RESUMO

Since the discovery of the B40 borospherene, research interests have been directed to the structural evolution of even larger boron clusters. An interesting question concerns if the borospherene cages persist in larger boron clusters like the fullerenes. Here we report a photoelectron spectroscopy (PES) and computational study on the structures and bonding of B41- and B42-, the largest boron clusters characterized experimentally thus far. The PE spectra of both clusters display broad and complicated features, suggesting the existence of multiple low-lying isomers. Global minimum searches for B41- reveal three low-lying isomers (I-III), which are all related to the planar B40- structure. Isomer II (Cs, 1A') possessing a double hexagonal vacancy is found to agree well with the experiment, while isomers I (Cs, 3A'') and III (Cs, 1A') both with a single hexagonal vacancy are also present as minor isomers in the experiment. The potential landscape of B42- is found to be much more complicated with numerous low-lying isomers (VII-XII). The quasi-planar structure VIII (C1, 2A) containing a double hexagonal vacancy is found to make major contributions to the observed PE spectrum of B42-, while the other low-lying isomers may also be present to give rise to a complicated spectral pattern. Chemical bonding analyses show isomer II of B41- (Cs, 1A') and isomer VIII of B42- (C1, 2A) are π aromatic, analogous to that in the polycyclic aromatic hydrocarbon C27H13+ (C2v, 1A1). Borospherene cage isomers are also found for both B41- and B42- in the global minimum searches, but they are much higher energy isomers.

16.
J Phys Chem Lett ; 10(21): 6472-6477, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31589447

RESUMO

We report photodetachment spectroscopy and high-resolution photoelectron imaging of para-halogen substituted phenoxide anions, p-XC6H4O- (X = F, Cl, Br, I). The dipole moments of the p-XC6H4O neutral radicals increase from 2.56 to 3.19 D for X = F to I, providing a series of similar molecules to allow the examination of charge-dipole interactions by minimizing molecule-dependent effects. Excited DBSs ([XC6H4O]*-) are observed for the four anions with binding energies of 8, 11, 24, and 53 cm-1, respectively, for X = F to I, below their respective detachment thresholds. The binding energies exhibit a linear correlation with the dipole moments of the neutral radicals, extrapolating to a critical dipole moment of 2.5 D for zero binding energy. Because of the small binding energy of the excited DBS of [FC6H4O]*-, rotational autodetachment is observed to compete with vibrational autodetachment in the resonant photoelectron spectra, resulting in electrons with near zero kinetic energies.

17.
J Am Chem Soc ; 141(44): 17854-17860, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31612714

RESUMO

Metallabenzenes are a class of molecules in which a CH unit in benzene is replaced by a functionalized transition-metal atom. While all-boron analogues of aromatic and antiaromatic hydrocarbons are well-known, there have not been any metallaboron analogs. We have produced and investigated two metal-doped boron clusters, ReB6- and AlB6-, using high-resolution photoelectron imaging and quantum chemical calculations. Vibrationally resolved photoelectron spectra have been obtained and compared with the theoretical results. The ReB6- cluster is found to be perfectly planar with a B-centered hexagonal structure (C2v, 1A1), while AlB6- is known to have a similar structure, but with a slightly out-of-plane distortion (Cs, 1A'). Chemical bonding analyses show that the closed-shell ReB6- is doubly σ- and π-aromatic, while AlB6- is known to be σ-aromatic and π-antiaromatic. The out-of-plane distortion in AlB6- is due to antiaromaticity, akin to the out-of-plane distortion of the prototypical antiaromatic cyclooctatetraene. The π-bonding in ReB6- is compared with that in both benzene and rhenabenzene [(CO)4ReC5H5], and remarkable similarities are found. Hence, ReB6- can be viewed as the first metallaboron analog of metallabenzenes and it may be viable for syntheses with suitable ligands.

18.
Endosc Int Open ; 7(10): E1207-E1213, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31579701

RESUMO

Background and study aims Published data on blue laser imaging (BLI) for detection and differentiation of colonic polyps are limited compared to narrow band imaging (NBI). This study investigated whether BLI can increase the detection rate of colonic polyps and adenomas when compared to white light imaging (WLI), and examined use of NICE (NBI International Colorectal Endoscopic) and JNET (Japan NBI Expert Team) classifications with BLI. Patients and methods Patients aged 50 years and above referred for colonoscopy were randomized to BLI or WLI on withdrawal. Detected polyps were characterized using NICE and JNET classifications under BLI mode and correlated with histology. Primary outcome was adenoma detection rate. Secondary outcomes were utility of NICE and JNET classifications to predict histology using BLI. Results A total of 182 patients were randomized to BLI (92) or WLI (90). Comparing BLI with WLI, the polyp detection rate was 59.8 % vs 40.0 %, P  = 0.008, and the adenoma detection rate was 46.2 % vs 27.8 %, P  = 0.010. NICE 1 and JNET 1 diagnosed hyperplastic polyps with sensitivity of 87.18 % and specificity of 84.35 %. NICE 2 diagnosed low- (LGD) or high-grade dysplasia (HGD) with sensitivity of 92.31 % and specificity of 77.45 %. JNET 2A diagnosed LGD with sensitivity of 91.95 %, and specificity of 74.53 %. Four cases of focal HGD all had JNET 2A morphology. Conclusion BLI increased adenoma detection rate compared to WLI. NICE and JNET classifications can be applied when using BLI for endoscopic diagnosis of HP and LGD but histological confirmation remains crucial.

19.
Gut ; 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31563876

RESUMO

OBJECTIVE: Pathological Wnt pathway activation is a conserved hallmark of colorectal cancer. Wnt-activating mutations can be divided into: i) ligand-independent (LI) alterations in intracellular signal transduction proteins (Adenomatous polyposis coli, ß-catenin), causing constitutive pathway activation and ii) ligand-dependent (LD) mutations affecting the synergistic R-Spondin axis (RNF43, RSPO-fusions) acting through amplification of endogenous Wnt signal transmembrane transduction. Our aim was to exploit differential Wnt target gene expression to generate a mutation-agnostic biomarker for LD tumours. DESIGN: We undertook harmonised multi-omic analysis of discovery (n=684) and validation cohorts (n=578) of colorectal tumours collated from publicly available data and the Stratification in Colorectal Cancer Consortium. We used mutation data to establish molecular ground truth and subdivide lesions into LI/LD tumour subsets. We contrasted transcriptional, methylation, morphological and clinical characteristics between groups. RESULTS: Wnt disrupting mutations were mutually exclusive. Desmoplastic stromal upregulation of RSPO may compensate for absence of epithelial mutation in a subset of stromal-rich tumours. Key Wnt negative regulator genes were differentially expressed between LD/LI tumours, with targeted hypermethylation of some genes (AXIN2, NKD1) occurring even in CIMP-negative LD cancers. AXIN2 mRNA expression was used as a discriminatory molecular biomarker to distinguish LD/LI tumours (area under the curve >0.93). CONCLUSIONS: Epigenetic suppression of appropriate Wnt negative feedback loops is selectively advantageous in LD tumours and differential AXIN2 expression in LD/LI lesions can be exploited as a molecular biomarker. Distinguishing between LD/LI tumour types is important; patients with LD tumours retain sensitivity to Wnt ligand inhibition and may be stratified at diagnosis to clinical trials of Porcupine inhibitors.

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